Table IV.
Module 2-General statements regarding and indications for sentinel lymph node identification during gastric cancer surgery
| Statements voted upon | No. of votes | Voting, % | Most common response | No. of rounds | Consensus, % |
|---|---|---|---|---|---|
| Consensus reached | |||||
| SLN navigation surgery can increase the applicability of local resection techniques (eg, ESD, WR, segmental resection, NEWS, CLEAN-NET, etc) in SLN negative cases. | 19 | 86.4 | Agree | 1 | 94.7 |
| Cancer deposits in a sentinel lymph node <2 mm in diameter (micro-metastasis) should be considered a positive node. | 21 | 95.5 | Agree | 1 | 86.4 |
| The SLN basin is best defined by a… (named artery area; lymph node area) | 20 | 100 | Lymph node area | 2 | 85.0 |
| There is a role for SLN dissection for early-stage cancers EVEN LARGER than 4 cm in diameter. | 19 | 95.0 | Disagree | 2 | 84.2 |
| SLN dissection only has a role in patients with T1 gastric cancer. | 18 | 90.0 | Agree | 2 | 83.3 |
| The best approach to SLN dissection is the… (pick-up method; SLN basin technique). | 17 | 85.0 | SLN basin | 2 | 82.4 |
| There is a role for SLN dissection in patients with any T-stage gastric cancer. | 20 | 90.9 | Disagree | 1 | 80.0 |
| A false negative rate >10% is acceptable for the clinical application of SLN navigation in gastric surgery. | 19 | 86.4 | Disagree | 1 | 78.9 |
| There is a role for SLN dissection for early-stage cancers <3 cm in diameter. | 19 | 95.0 | Agree | 2 | 78.9 |
| There is a role for SLN dissection even in cases where endoscopic resection is the only management of the primary tumor (EMR or ESD). | 19 | 95.0 | Agree | 2 | 78.9 |
| There is a role for SLN dissection for early-stage cancers <4 cm in diameter. | 20 | 90.9 | Agree | 1 | 75.0 |
| Intraoperative frozen section evaluation with H&E staining is an acceptable modality for the identification of positive SLNs in gastric cancer. | 18 | 90.0 | Agree | 2 | 72.2 |
| Frozen section with H&E is not enough for the diagnosis of positive SLNs and more advanced pathologic methods should be used (eg, serial sectioning, IHC, and/or PCR). | 18 | 81.8 | Agree | 1 | 72.2 |
| No consensus reached | |||||
| Frozen section is inadequate for identification of positive SLNs regardless of pathologic modality used (only permanent section is appropriate for clinical decision-making). | 20 | 100 | Agree | 2 | 65.0 |
| SLN dissection should be used for decision-making re: the extent of gastric resection (versus a standard resection schema (distal/subtotal/total) based solely on tumor location… (N, S, M, A). | 19 | 95.0 | Sometimes | 2 | 63.2 |
| SLN dissection should be used for decision-making regarding the extent of lymphadenectomy (versus routine D2 lymphadenectomy)… (N, S, M, A) | 19 | 95.0 | Most times | 2 | 63.2 |
| SLN dissection is for research purposes only and has no role in clinical practice. | 19 | 95.0 | Agree | 2 | 63.2 |
| There is a role for SLN dissection in patients with T1 & T2 gastric cancer. | 18 | 90.0 | Agree | 2 | 61.1 |
Average consensus ¼ 76.2%.
CLEAN-NET, combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique; EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection; FI, fluorescence imaging; H&E, hematoxylin and eosin; ICG, indocyanine green; IHC, immunohistochemistry; NEWS, nonexposure endoscopic wall-inversion surgery; NIR, near-infrared; (N, S, M, A), never, sometimes, most of the time, always; PCR, polymerase chain reaction; SLN, sentinel lymph node; WR, wedge resection.